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EDITORIAL: Ensure coverage regardless of pre-existing conditions

Citizens' Voice, The (Wilkes-Barre, PA)

June 12--The Trump administration imperiled access to health care for millions of Americans last week when it declined to defend in court the Affordable Care Act's provision that health insurers may not deny coverage based on pre-existing conditions.

Attorneys general of 20 Republican-controlled states filed a federal suit in February in Texas, arguing that the entire ACA should be ruled unconstitutional. In the tax law it passed in December, Congress eliminated the tax penalty for individuals who do not acquire health insurance. That requirement, in turn, ensured that insurers would have adequate revenue to cover everyone, regardless of pre-existing conditions. Without the individual mandate, the attorneys general argued, the law cannot constitutionally compel insurers to cover everyone regardless of pre-existing conditions.

Before the ACA took effect in 2014, insurers routinely denied coverage or determined rates based on pre-existing conditions. It is not clear how eliminating the ACA coverage mandate regardless of pre-existing conditions would play out, since there is no standard definition of a pre-existing condition -- different insurers defined them and rated them differently. But the Kaiser Family Foundation estimates that 27 percent of people younger than 65 (Medicare coverage age) have a pre-existing condition that would affect their insurance access or cost.

Whatever the controversies that have plagued the ACA, coverage regardless of pre-existing conditions is its most popular feature. Kaiser polling consistently has shown it to have an 70 percent approval rating among all Americans, including 59 percent of Republicans.

But this is another case of the administration hewing to a narrow base, even at the expense of health care for millions. But it could backfire. After Congress eliminated the tax penalty for enrollment, ACA enrollment declined by only 3.7 percent. It is abundantly clear that Americans want coverage regardless of pre-existing conditions, and Congress should ensure that they have access to it.